Evaluation of a Novel Antegrade-to-Retrograde Femoral Sheath Conversion System: A Preclinical, Cadaveric Study

Peripheral arterial disease often affects the lower extremities, is frequently bilateral, and typically involves multiple leg segments. Symptomatic disease is usually treated endovascularly. Antegrade access may be necessary in some cases and can be challenging compared with retrograde common femoral artery access. The ability to convert a conventional retrograde access to antegrade access would thus be valuable. We developed and tested a novel system, named as antegrade-to-retrograde converter. Our aim was to establish antegrade superficial femoral artery access from initial retrograde entry and reconvert to retrograde access.

We tested the antegrade-to-retrograde converter bilaterally in 15 fresh (unembalmed) human cadavers. We used the converter and its accessories to convert an initial retrograde common femoral artery access to an antegrade orientation in the superficial femoral artery and then to reconvert to retrograde access.

There were 5 men and 10 women cadavers, with an average age of 79 (range, 56-93) years. We were able to obtain antegrade wire access after initial retrograde common femoral artery puncture in 100% (30/30) of the procedures. We were similarly able to obtain retrograde wire access after successful antegrade access during all 30 attempts. During antegrade conversion, usable superficial femoral artery access was achieved in 27 of 30 (90%) attempts, with the remaining resulting in profunda femoris artery access. The primary end point was therefore achieved in 90% of the procedures.

The antegrade-to-retrograde converter may be useful for peripheral vascular interventions. Studies in patients need to be performed.